Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Surgical Management and Long-Term Results of Rathke's Cleft Cyst

  • Seung-Ho, Seo (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Kihwan, Hwang (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • So Young, Ji (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Jung Ho, Han (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Chae-Yong, Kim (Department of Neurosurgery, Seoul National University Bundang Hospital)
  • Received : 2022.06.15
  • Accepted : 2022.09.02
  • Published : 2023.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Rathke's cleft cysts (RCCs) are nonneoplastic cysts. Most of them are asymptomatic and stable; when symptomatic, RCCs are surgically fenestrated and drained. However, the outcomes remain unclear. The authors evaluated the outcomes of RCC decompression. Methods : Between 2004 and 2019, 32 RCCs were decompressed in a single tertiary institution. The clinical characteristics, intraoperative findings, postoperative complications, and endocrinological and surgical outcomes were retrospectively reviewed. Patients who underwent sequential imaging at least twice and at least 12 months after surgery were included in the analysis. Results : Patients' mean age was 40.8±14.9 years, and 62.5% were women. The mean follow-up duration was 62.3±48.6 months. In 21 patients (65.6%), no residual cysts were identified on postoperative magnetic resonance imaging. Of the 18 patients with preoperative visual field defects, 17 (94.4%) experienced postoperative visual improvement. Postoperative complications included endocrinological deterioration in 11 patients (34.4%), permanent diabetes insipidus in 11 (34.4%), infection in four (12.5%), intrasellar hemorrhage in three (9.4%), and cerebrospinal fluid leak in two (6.3%). Follow-up images revealed cyst recurrence in nine patients (28.1%), an average of 20.4 months after surgery; in three patients, the cysts were symptomatic, and resection was repeated. Multivariable analysis revealed that postoperative endocrinological deterioration was the only independent factor associated with cyst recurrence (p=0.028; hazard ratio, 6.800). Conclusion : Our findings showed that although only cyst fenestration for decompression was performed to preserve pituitary function, more pituitary dysfunction occurred than expected. Besides, the postoperative hormonal deterioration itself acted as a risk factor for cyst recurrence. In conclusion, surgery for RCC should be more careful.

Keywords

References

  1. Aho CJ, Liu C, Zelman V, Couldwell WT, Weiss MH : Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg 102 : 189-193, 2005  https://doi.org/10.3171/sup.2005.102.s_supplement.0189
  2. Barkhoudarian G, Palejwala SK, Ansari S, Eisenberg AA, Huang X, Griffiths CF, et al. : Rathke's cleft cysts: a 6-year experience of surgery vs. observation with comparative volumetric analysis. Pituitary 22 : 362-371, 2019  https://doi.org/10.1007/s11102-019-00962-y
  3. Benveniste RJ, King WA, Walsh J, Lee JS, Naidich TP, Post KD : Surgery for Rathke cleft cysts: technical considerations and outcomes. J Neurosurg 101 : 577-584, 2004  https://doi.org/10.3171/jns.2004.101.4.0577
  4. Cabuk B, Selek A, Emengen A, Anik I, Canturk Z, Ceylan S : Clinicopathologic characteristics and endoscopic surgical outcomes of symptomatic Rathke's cleft cysts. World Neurosurg 132 : e208-e216, 2019  https://doi.org/10.1016/j.wneu.2019.08.196
  5. Higgins DM, Van Gompel JJ, Nippoldt TB, Meyer FB : Symptomatic Rathke cleft cysts: extent of resection and surgical complications. Neurosurg Focus 31 : E2, 2011  https://doi.org/10.3171/2011.5.FOCUS1175
  6. Hwang K, Kim YH, Kim JH, Lee JH, Yang HK, Hwang JM, et al. : The outcomes of conservatively observed asymptomatic nonfunctioning pituitary adenomas with optic nerve compression. J Neurosurg 134 : 1808-1815, 2020 
  7. Isono M, Kamida T, Kobayashi H, Shimomura T, Matsuyama J : Clinical features of symptomatic Rathke's cleft cyst. Clin Neurol Neurosurg 103 : 96-100, 2001  https://doi.org/10.1016/S0303-8467(01)00121-4
  8. Kim E : Symptomatic Rathke cleft cyst: clinical features and surgical outcomes. World Neurosurg 78 : 527-534, 2012  https://doi.org/10.1016/j.wneu.2011.12.091
  9. Kim JE, Kim JH, Kim OL, Paek SH, Kim DG, Chi JG, et al. : Surgical treatment of symptomatic Rathke cleft cysts: clinical features and results with special attention to recurrence. J Neurosurg 100 : 33-40, 2004  https://doi.org/10.3171/jns.2004.100.1.0033
  10. Koutourousiou M, Grotenhuis A, Kontogeorgos G, Seretis A : Treatment of Rathke's cleft cysts: experience at a single centre. J Clin Neurosci 16 : 900-903, 2009  https://doi.org/10.1016/j.jocn.2008.10.007
  11. Lee C, Park SH : Spontaneously regressed Rathke's cleft cyst. J Korean Neurosurg Soc 62 : 723-726, 2019  https://doi.org/10.3340/jkns.2018.0225
  12. Lillehei KO, Widdel L, Astete CA, Wierman ME, Kleinschmidt-DeMasters BK, Kerr JM : Transsphenoidal resection of 82 Rathke cleft cysts: limited value of alcohol cauterization in reducing recurrence rates. J Neurosurg 114 : 310-317, 2011  https://doi.org/10.3171/2010.7.JNS091793
  13. Lin M, Wedemeyer MA, Bradley D, Donoho DA, Fredrickson VL, Weiss MH, et al. : Long-term surgical outcomes following transsphenoidal surgery in patients with Rathke's cleft cysts. J Neurosurg 130 : 831-837, 2018  https://doi.org/10.3171/2017.11.jns171498
  14. Mendelson ZS, Husain Q, Elmoursi S, Svider PF, Eloy JA, Liu JK : Rathke's cleft cyst recurrence after transsphenoidal surgery: a meta-analysis of 1151 cases. J Clin Neurosci 21 : 378-385, 2014  https://doi.org/10.1016/j.jocn.2013.07.008
  15. Montaser AS, Catalino MP, Laws ER : Professor Rathke's gift to neurosurgery: the cyst, its diagnosis, surgical management, and outcomes. Pituitary 24 : 787-796, 2021  https://doi.org/10.1007/s11102-021-01155-2
  16. Nishioka H, Haraoka J, Izawa H, Ikeda Y : Headaches associated with Rathke's cleft cyst. Headache 46 : 1580-1586, 2006  https://doi.org/10.1111/j.1526-4610.2006.00539.x
  17. Ogawa Y, Tominaga T, Ikeda H : Clinicopathological and endocrinological study of Rathke's cleft cyst manifesting as hyponatremia. Neurol Med Chir (Tokyo) 47 : 58-63; discussion 63-64, 2007  https://doi.org/10.2176/nmc.47.58
  18. Osborn AG, Preece MT : Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology 239 : 650-664, 2006  https://doi.org/10.1148/radiol.2393050823
  19. Petersson M, Berinder K, Eden Engstrom B, Tsatsaris E, Ekman B, Wahlberg J, et al. : Natural history and surgical outcome of Rathke's cleft cysts-a study from the Swedish Pituitary Registry. Clin Endocrinol (Oxf) 96 : 54-61, 2022  https://doi.org/10.1111/cen.14622
  20. Prabhu VC, Brown HG : The pathogenesis of craniopharyngiomas. Childs Nerv Syst 21 : 622-627, 2005  https://doi.org/10.1007/s00381-005-1190-9
  21. Ratha V, Patil S, Karmarkar VS, Shah NJ, Deopujari CE : Surgical management of Rathke cleft cysts. World Neurosurg 107 : 276-284, 2017  https://doi.org/10.1016/j.wneu.2017.07.164
  22. Sala E, Moore JM, Amorin A, Carosi G, Martinez H Jr, Harsh GR, et al. : Natural history of Rathke's cleft cysts: a retrospective analysis of a two centres experience. Clin Endocrinol (Oxf) 89 : 178-186, 2018  https://doi.org/10.1111/cen.13744
  23. Shatri J, Ahmetgjekaj I : Rathke's cleft cyst or pituitary apoplexy: a case report and literature review. Open Access Maced J Med Sci 6 : 544-547, 2018  https://doi.org/10.3889/oamjms.2018.115
  24. Yamada H, Ueda R, Ozawa H, Toda M : Long-term outcomes of endoscopic cyst fenestration for Rathke cleft cyst. World Neurosurg 161 : e282-e288, 2022  https://doi.org/10.1016/j.wneu.2022.01.118
  25. Zada G : Rathke cleft cysts: a review of clinical and surgical management. Neurosurg Focus 31 : E1, 2011 https://doi.org/10.3171/2011.5.FOCUS1183